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90_HB1400
215 ILCS 105/5 from Ch. 73, par. 1305
Amends the Comprehensive Health Insurance Plan Act.
Provides that the Plan shall be administered by a plan
administrator rather than an administering carrier. Provides
that criteria for bids to administer the Plan shall include
disclosure of discounts or income that may be derived by the
Plan and the timeliness of claim processing procedures.
Effective July 1, 1997.
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1 AN ACT to amend the Comprehensive Health Insurance Plan
2 Act by changing Section 5.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The Comprehensive Health Insurance Plan Act
6 is amended by changing Section 5 as follows:
7 (215 ILCS 105/5) (from Ch. 73, par. 1305)
8 Sec. 5. Plan administrator Administering Carrier.
9 a. The board shall select a plan administrator an
10 administering carrier through a competitive bidding process
11 to administer the plan. The board shall evaluate bids
12 submitted under this Section based on criteria established by
13 the board which shall include:
14 (1) The administrator's carrier's proven ability to
15 handle other large group accident and health benefit plans.
16 (2) The efficiency and timeliness of the administrator's
17 carrier's claim processing paying procedures.
18 (3) An estimate of total net cost charges for
19 administering the plan, including any discounts or income the
20 Plan could expect to receive or benefit from.
21 (4) The administrator's ability to apply effective cost
22 containment programs and procedures and of the carrier to
23 administer the plan in a cost-efficient manner.
24 (5) The financial condition and stability of the
25 administrator carrier.
26 b. The plan administrator administering carrier shall
27 serve for a period of 5 years subject to removal for cause
28 and subject to the terms, conditions and limitations of the
29 contract between the board and the plan administrator
30 administering carrier. At least one year prior to the
31 expiration of each 5 year period of service by the current
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1 plan administrator an administering carrier, the board shall
2 begin to advertise for and accept bids to serve as the plan
3 administrator administering carrier for the succeeding 5 year
4 period. Selection of the plan administrator administering
5 carrier for the succeeding period shall be made at least 6
6 months prior to the end of the current 5 year period.
7 c. The plan administrator administering carrier shall
8 perform such eligibility and administrative claims payment
9 functions relating to the plan as may be assigned to it
10 including:
11 (1) The establishment of administering carrier shall
12 establish a premium billing procedure for collection of
13 premiums from plan participants. Billings shall be made on a
14 periodic basis as determined by the board.
15 (2) Processing of claims and various cost containment
16 functions.
17 (3) (2) Other The administering carrier shall perform
18 all necessary functions to assure timely payment of benefits
19 to participants under the plan, including:
20 (a) Making available information relating to the proper
21 manner of submitting a claim for benefits under the plan and
22 distributing forms upon which submissions shall be made.
23 (b) Evaluating the eligibility of each claim for payment
24 under the plan.
25 (c) The administrator administering carrier shall be
26 governed by the requirements of Part 919 of Title 50 of the
27 Illinois Administrative Code, promulgated by the Department
28 of Insurance, regarding the handling of claims under this
29 Act.
30 d. The administrator administering carrier shall submit
31 regular reports to the board regarding the operation of the
32 plan. The frequency, content and form of the report shall be
33 as determined by the board.
34 e. The administrator administering carrier shall pay or
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1 be reimbursed for claims expenses from the premium payments
2 received from or on behalf of plan participants. If the
3 administrator's administering carrier's payments or
4 reimbursements for claims expenses exceed the portion of
5 premiums allocated by the board for payment of claims
6 expenses, the board shall provide to the administering
7 carrier additional funds to the administrator for payment or
8 reimbursement of such claims expenses.
9 f. The administrator administering carrier shall be paid
10 as provided in the board's contract between the Board and the
11 plan administrator with the administering carrier for
12 expenses incurred in the performance of its services.
13 (Source: P.A. 85-1013.)
14 Section 99. Effective date. This Act takes effect July
15 1, 1997.